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On Aug 2018




Dr. Mamta Gupta,
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Aug 2018




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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
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On April 2011
Anuradha

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Dr. Anuradha
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On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : QC13 - QC16 Full Version

Oral Health Awareness and Practices among Pregnant Women Receiving Antenatal Care in a Low Resource Setting: A Cross-sectional Study of Antenatal Attendees in Enugu, Southeastern Nigeria


Published: August 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/48349.15304
Chidinma Ifechi Onwuka, Peter Chukwudi Udealor, Emeka Iloghalu, Chidozie Ifechi Onwuka, Euzebus Chinonye Ezugwu, Ifeanyi Emmanuel Menuba

1. Senior Lecturer, Department of Obstetrics and Gynaecology, UNN/UNTH, Enugu, Nigeria. 2. Lecturer, Department of Obstetrics and Gynaecology, UNN/UNTH, Enugu, Nigeria. 3. Senior Lecturer, Department of Obstetrics and Gynaecology, UNN/UNTH, Enugu, Nigeria. 4. Assistant Professor, Department of Oral and Maxillofacial Surgery, King Khalid University, Abha, Saudi Arabia. 5. Professor, Department of Obstetrics and Gynaecology, UNN/UNTH, Enugu, Nigeria. 6. Lecturer, Department of Obstetrics and Gynaecology, UNN/UNTH, Enugu, Nigeria.

Correspondence Address :
Dr. Chidinma Ifechi Onwuka,
Senior Lecturer, Department of Obstetrics and Gynaecology, UNN/UNTH,
Ituku/Ozalla, Enugu, Nigeria.
E-mail: cifechi@yahoo.com

Abstract

Introduction: Poor oral health status in pregnant women is known to be associated with poor outcomes in pregnancies. Despite this, the oral health status of pregnant women has been grossly overlooked during antenatal period.

Aim: To determine the awareness and practices of oral health among pregnant women in Enugu, Southeastern Nigeria.

Materials and Methods: This was a cross-sectional questionnaire based study of 413 women who attended the antenatal clinic of University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla from January 2018 to May 2018. An interviewer administered semi-structured questionnaire which was pretested before the commencement of the study was used. The information obtained was analysed using Statistical Package for the Social Sciences (SPSS) version 22.0. A p-value of <0.05 was considered statistically significant.

Results: A total of 350 (84.75%) of the respondents used toothbrush and toothpaste for oral cleaning, 229 (55.45%) brushed at least twice a day while 258 (62.5%) changed their brushes every three months. Only 161 (39%) of the respondents knew that pregnancy can affect oral health while 101 (24.5%) of the respondents knew that poor oral health in pregnancy could have adverse effects on the unborn child; of whom only 30 (29.70%) got the information from their Obstetricians.

Conclusion: There were knowledge gaps in the oral health of pregnant women in Enugu southeastern Nigeria. It is therefore important to provide oral health education for pregnant women during antenatal period in order to improve the health of the mother and her baby.

Keywords

Gingivitis, Obstetrician, Periodontal diseases, Pregnancy

The oral health of pregnant women is important because several complex physiological changes occur in the mouth during pregnancy (1),(2),(3). The gingiva is most commonly affected in pregnancy due to the increase in oestrogen level that is associated with pregnancy and this may lead to bleeding gums in pregnancy (2).

Periodontal disease caused by gram negative anaerobic organisms (4) are one of the most infectious diseases in human (2). Pregnant women are more likely to develop periodontal diseases especially gingivitis (5) because of hormonal influences. Gingivitis is the inflammation of the tissues surrounding a tooth but there is no loss of periodontal attachment (6). Periodontal disease may also present as periodontitis, which is the inflammation and destruction of supporting tissues around the teeth (6). There could be a connection between periodontal disease and adverse pregnancy outcome like preterm births, intrauterine growth restriction and pre-eclampsia (1),(2),(4),(5). High level of cariogenic bacteria in mothers has been associated with an increase in dental caries in the infants (7). Periodontal disease can be prevented as well as treated by controlling plaques through flossing, brushing and scaling and polishing (6).

Although, oral health is important, many pregnant women do not seek oral care; even those with obvious disease of the oral cavity (3). In addition, many healthcare givers including obstetricians do not seem to take a keen interest in the oral health of pregnant women. This may probably be because they do not understand the importance of the oral health of the pregnant women or they are being too cautious because of concerns for foetal safety during dental treatment (7). This fear is unfounded because dental treatment can be safely carried out at any time during pregnancy (6).

Pregnancy, however, is important period in a woman’s lifetime when the woman can be encouraged to adopt healthy changes to improve their oral health and extend it to her offspring (6). In addition, health professionals need to encourage to take care of the maternal oral health in order to improve pregnancy outcomes and reduce the risk of childhood caries (6). These can be achieved by the prevention of oral diseases, early diagnosis and referral to a dentist (6).

World Health Organisation (WHO) recognises the importance of oral health. Oral health disease is said to be a major burden on health programs on many countries (8). WHO is committed to ensure oral health by shifting the focus from invasive dental treatment to prevention and more of minor treatment instead (8). Pregnancy being a “teachable” time gives a good opportunity for prevention of oral diseases and also reduces the dental caries among the offsprings (9). In Nigeria, until recently, there was no clear oral health policy despite the importance of oral health and WHO recommendation (10). The national oral health policy which is aimed at seeking an improvement in the health status of the people by making oral healthcare part of the primary healthcare was recently adopted, but its full implementation has not started (10),(11).

Very little is known about the oral health of pregnant women in Enugu, southeastern Nigeria, thus necessitating this study. The information generated will hopefully help in developing policies and programmes that will help in improving the oral health of pregnant women in the region and by extension improve their obstetric outcome. The aim of this study was to assess the knowledge and practices of oral health among pregnant women in Enugu, Nigeria.

Material and Methods

This was a cross-sectional questionnaire based study of consecutive women who attended the antenatal clinic of University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu State, Nigeria from January 2018 to May 2018. UNTH is a Federal tertiary hospital situated in Ituku Ozalla which is at the outskirt of Enugu State. It offers antenatal care to pregnant women on a daily basis from Monday to Friday. Pregnant women are usually seen four weekly until 28 weeks, two weekly until 36 weeks, and then weekly until delivery. Ethical approval was obtained from the University of Nigeria Teaching Hospital Health Research Ethics Committee (Ref. UNTH/CSA/329/Vol.5). An informed consent was obtained from the respondents and they were reassured of the confidentiality of the information obtained.

Inclusion criteria: Pregnant women attending the antenatal clinic of the hospital within the study period who gave their consent were included in the study.

Exclusion criteria: However, pregnant women with dentures, oral malignancies and those who failed to give consent were excluded from the study.

The sample size was calculated using the formula n=Z2pq/d2 where p was set as 50%. The minimum sample size thus calculated was 384 participants. However, this was increased by 10% to 422 participants to cover for attrition. Convenient sampling method was used in selecting the participants.

The questionnaire which was adapted from previous studies (12),(13) was interviewer administered questions which were divided into three sections. The first section contained questions pertaining to the socio-demographic characteristics of the respondents (age, address, occupation, marital status, religion, tribe, educational status and the number of children the respondent had). The second section contained five questions assessing the oral health knowledge of the respondents while the third section contained six questions assessing the oral health practices of the respondents. The questionnaire was pretested among antenatal clinic attendees at the Enugu State University Teaching Hospital, a state owned sister teaching hospital in Enugu to allow for adjustment of the questions in order to facilitate answering before the commencement of the study. The questionnaires were then consecutively administered to consenting women by trained interviewers until the sample size was reached.

Education was categorised as primary, secondary and tertiary (such polytechnic and university education) (13). Parity was categorised as primigravida, multiparous (1-4 deliveries) and grand multiparous (≥5). Women with good oral health practices were those who brushed at least twice daily with toothbrush and paste and changed their toothbrushes at least every three months. Oral health knowledge was categorised into yes and no response.

Statistical Analysis

The data was analysed using SPSS for windows version 22.0 (SPSS Inc. Chicago IL). Statistical analysis was both descriptive and cross tabulation of socio-demographic characteristics and inference determined by chi-square. A p-value<0.05 was considered statistically significant.

Results

A total of 413 questionnaires were properly completed and analysed. Majority of the respondents were Christians (n=397, 96.12%), 165 (39.95%) were salary earners while 232 (56.17%) were multiparous women. Further details of the socio-demographic characteristics of the respondents are shown in (Table/Fig 1).

Only 30 (29.70%) of the women who knew that oral health in pregnancy could have adverse effects on the unborn child got the information from their obstetricians (Table/Fig 2). Majority (n=350, 84.75) of the respondents used toothbrush and toothpaste for oral cleaning. Further details of the oral health pattern of the respondents are in (Table/Fig 3). Although 83.8% (n=346) of the respondents agreed that women should have dental checkup during pregnancy, only 36 (8.7%) actually had dental checkup while the majority (n=377, 91.3%) did not.

Age, occupation, religion and educational status showed significant association with awareness of effects of pregnancy on oral health whereas place of residence did not (Table/Fig 4). Age, occupation, religion and educational status showed significant association with awareness of effects of poor oral health on the unborn child whereas place of residence did not (Table/Fig 5).

Discussion

It has been established that good oral health during pregnancy is important in achieving favorable pregnancy outcome (13). Periodontal disease which is the most common oral disease in pregnancy can be prevented by good oral care including flossing and regular brushing (13). Good oral care practices can be influenced by an individual’s oral health knowledge (13). However, there were gaps in the oral health knowledge among pregnant women in Enugu as observed in the index study which was a cross-sectional study. Only 39% and 24.5% were aware that pregnancy has effects on oral health and that poor oral health could have adverse effects on pregnancy outcome unlike in previous study were the participants displayed average/good oral health knowledge (6),(13). Even though majority of the participants were highly educated like in previous study carried out in the South-south of Nigeria (12), it would have been expected that the participants would have above average oral health knowledge but this was not the case in present study.

Oral health awareness showed significant association with age, educational status, occupation and religion. Just like in previous studies; the more educated a woman is the better the knowledge (6),(13). However, a similar study showed that though majority of the respondents were educated, half of them were not aware of oral health problems (12).

Although there were gaps in oral health knowledge of the participants, a good number had good oral health practices. Above average number of the participants in present study brushed at least twice daily while the majority of them used toothpaste and brush for oral care as well as changed their toothbrushes once in three months. A similar result was obtained in a study carried out in Calabar where 94.4% used toothbrush and toothpaste for oral cleaning and 89.9% in North eastern Nigeria (2),(12). However, in previous studies, majority of the women believed that brushing should be done twice daily but only few of them actually brushed twice daily (9),(14),(15). This may be attributed to the cultural beliefs and practices of the different population.

The majority of women in present study believed that women should have dental checkup during pregnancy, only 8.7% actually had dental checkup. Similar report of low dental service utilisation has been reported (6),(12). These low dental services may be attributed to poor exposure of pregnant women to oral healthcare knowledge by the obstetricians and even the dentists. In present study, only 29.7% of the women got information about oral health from their obstetricians. Further studies on the determinants of dental consultation between pregnant women in Enugu and the obstetricians’ knowledge and attitude regarding oral health would be worthwhile.

Limitation(s)

This study had some limitations therefore the results should be reported with caution. The study was based on self-reported data so there may be elements of biases and may not have reflected the opinions of the respondents. Another limitation was that convenient sampling method was used to select the participants. The study was carried out in a tertiary institution with majority of the women being educated and living in urban areas of Enugu and therefore the results may not be generalised.

Conclusion

There were knowledge gaps in the oral health of pregnant women in Enugu southeastern Nigeria. It is therefore important to provide oral health education for pregnant women during antenatal period in order to improve the health of the mother and her baby.

References

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Adeniyi A, Agbaje O, Braimoh M, Ogunbanjo O, Modupe S, Olubunmi O. A survey of the oral health knowledge and practices of pregnant women in a Nigerian teaching hospital. Afr J Reprod Health. 2011;15(4):14-19.
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Agbelusi GA, Sofola OO, Jeboda SO. Oral health knowledge, attitude and practices of pregnant women in Lagos University Teaching Hospital. Nig Qt J Hosp Med. 1999;9(2):116-20. [crossref]
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DOI and Others

10.7860/JCDR/2021/48349.15304

Date of Submission: Dec 31, 2020
Date of Peer Review: Apr 03, 2021
Date of Acceptance: Jul 06, 2021
Date of Publishing: Aug 01, 2021

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 14, 2021
• Manual Googling: Jul 05, 2021
• iThenticate Software: Jul 31, 2021 (16%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com